Cost effectiveness comparison between pituitary down regulation with a gonadotropin releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Capsule:
Although the controlled ovarian stimulation protocol with short GnRH agonist in alternate days may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy.

Authors:
Luiz Guilherme Louzada Maldonado, M.D., José Gonçalves Franco Jr., M.D., Ph.D., Amanda Souza Setti, M.Sc., Assumpto Iaconelli, Jr., M.D., Edson Borges, Jr., M.D., Ph.D.

Volume 99, Issue 6, Pages 1615-1622, May 2013

Abstract:

Objective:
To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome.

Study design:
Prospective, randomized.

Setting:
A private center.

Patient(s):
Patients were randomized in two groups: GnRHa (n=48) and GnRHant (n=48) groups.

Intervention(s):
The GnRHa stimulation protocol: administration of the triptorelin in alternate days starting on the 1st day of the cycle, recombinant FSH (rFSH) and recombinant hCG (rhCG) microdose. The GnRHant protocol: administration of a daily dose of rFSH, cetrorelix and rhCG microdose.

Main Outcome Measure(s):
ICSI outcomes and treatments costs.

Result(s):
A significant lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group as compared to the GnRHant group ($5,327.80 ± 387.30 and $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1430.0 and $11,328.70 ± 907.20).

Conclusion(s):
Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy.

Clinical Trial Registration Number:
NCT01468441.

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